Neonatal Repair of Tetralogy of Fallot Results in Improved Pulmonary Artery Development Without Increased Need for Reintervention

Objective: Despite a continuous improvement in operative outcome the optimal timing for the repair of tetralogy of Fallot (TOF) remains controversial. The purpose of this study was to evaluate the results following neonatal repair of TOF and the need for reintervention associated with this strategy.

Methods: Retrospective review of 66 consecutive patients with TOF and confluent pulmonary arteries, who underwent repair immediately after diagnosis. Group I (n=46) had a median age of 5 days (1-29) and Group II (n=20) had a median age of 56 days (32-270). A transventricular approach was used in all cases, and 58/66 (88%) patients received a transannular patch. The median follow-up interval was 35 months (1-79).

Results: There were three early deaths (4.5%) and no late deaths for an actuarial survival rate of 95.4% at 1 and 5 years. Univariate analysis of patient and procedural variables demonstrated that early mortality was only influenced by associated non-cardiac conditions (P=0.04). At median interval of 9.8 months (3-41), 12 patients required additional intervention. During the follow-up period, a significant increase in Nakata index was observed only among neonates. Freedom from reintervention at 1 month, 1 and 5 years was: 100, 84.2 and 81% in group I and 100, 84, 78.9% in group II. Surgical weight below 2.5 kg (P<0.001), low arterial saturation in the early postoperative period (P=0.04) and small preoperative branch pulmonary artery size (<0.01) were associated with need for reintervention during follow-up.

Conclusions: Elective repair of TOF in neonates with confluent central pulmonary arteries has excellent results in the absence of significant associated non-cardiac conditions. While enhancing the development and growth of the pulmonary arteries, neonatal repair affords a freedom from reintervention no different from patients repaired during infancy. Preoperative weight < 2.5 kg and small left pulmonary artery size are associated with higher incidence reintervention during follow-up.